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HomeMy WebLinkAbout295 Rye Street - Life Safety System Test (2) Form 4 Automatic Sprinkler Systems 100o Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative.All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners,and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material,poor workmanship,or failure to comply with approving authority's requirements or local ordinances. Property Name: L�I S Illy j�tL 4{�Y/5 Date: Property Address: �9.5 /eYE - �-�^T '�vuTN U)i�yDSaQ l'T 4607 Accepted by approving authorities(names) K'/fLTC-x- Si,L"wA,- F,-Re-,I i;tt11+, - L Address * Plans Installation conforms to accepted plans ® Yes ❑No Equipment used is approved.If no,explain deviations Yes ❑No Has person in charge of fire equipment been instructed as to location Yes ❑No of control valves and care and maintenance of this new equipment? If no,explain Instructions Have copies of the following been left on the premises? ❑ Yes ❑No 1.System components instructions [ Yes ❑No 2.Care and maintenance instructions Yes ❑No 3.NFPA 25 ® Yes ❑No Location of Supplies buildings : z�oNt 17 system Make Model Year of Orifice Quantity Temperature manufacture size rating L D a 1 -5-1y Sprinklers Pipe and Type of pipet_�3 �3Q s Ic L fittings Type of fittings 6,fl-VAA)17 t D ram• NFPA Water-Based Fire Protection Systems Forms 1 of 4 Form 4 a Maximum time to operate Alarm valve Alarm device through test connection or flow Type Make Indicator Dry valve Q.O.D Make Model Serial No. Make Model Serial No. Time to trip Trip Time water Alarm through test Water Air point air reached test operated Dry pipe connectlont'Z 1 'pressure pressurepressure- outlet''= properly operating test Minutes Seconds psi psi psi min, see. Yes No Without Q.0.1) With Q.O.D If no explain: Operation ®Pneumatic [R Electric ❑Hydraulic Piping supervised P Yes ❑No Detecting media supervised (3Yes ❑No Does valve operate from t anual 'l emote,or both control ©Yes ❑No Is there an accessible facility in each circuit for testing? [5-Yes ❑No Deluge and preaetion If no,explain valves Make GT I/L Model "7 (a 9 Does each circuit operate supervision loss alarm? { Yes ❑No Does each circuit operate valve release? ❑Yes ®No Maximum time to operate release Minutes Seconds Pressure Location and floor Residual pressure Flow reducing valve Static pressure (flowing) rate test Make and model Inlet Outlet Inlet Outlet Flow (psi) (psi) (psi) (psi) (gpm) Setting Test Hydrostatic:Hydrostatic tests shall be made at not less than 200 psi(13.6 bar)for 2 hours or 50 psi description (3.4 bar)above static pressure excess of 150 psi(10.2 bar)for 2 hours.Differential dry-pipe clappers shall be left open during the test to prevent damage.All aboveground piping leakage shall be stopped. Pneumatic:Establish 40 psi(2.7 bar)air pressure and measure drop,which shall not exceed 1%psi (0.1 bar)in 24 hours.Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall not exceed 1'h psi(0.1 bar)in 24 hours. Measured from time inspector's test connection is opened 2 NFPA 13 only requires the 60-second limitation in specific sections NFPA Water-Based Fire Protection Systems Forms 2 of 4 Form 4 All piping hydrostatically tested at( yo ell for, hours If no,state reason Dry piping pneumatically Yes ❑ No Equipment operates Yes ❑ No Do you certify as the sprinkler contractor that additives and corrosive chemicals,sodium silicate or derivatives of sodium silicate,brine,or other Yes ❑No corrosive chemicals were not used for testing systems or stopping leaks? Drain Reading of cutoff gauge located near water supply test connection: psi( bar) Tests test: Residual pressure with valve in test connection open wide: psi( bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping flLgVtdtlS Verified by copy of the Contractor's Material and Test Certificate for Underground Piping ❑ Yes ❑No 215ther Explain: Z�'XrsTtNbj 5y5-TCA5 Flushed by installer of underground sprinkler piping ❑ Yes ❑No If powder-driven fasteners are used in concrete,has representative sample ❑ Yes ❑No testing been satisfactorily completed? If no,explain Blank Number used Locations Number removed testing gaskets Welding piping ❑ Yes ®No If es Do you certify as the sprinkler contractor that welding procedures used ❑ Yes ❑ No complied with the minimum requirements of AWS B2.1,ASME Section IX Welding and Brazing Qualifications,or other applicable qualification standard as required by the AHJ? Do you certify that the welding was performed by welders or welding operators ❑ Yes ❑ No qualified in accordance with the minimum requirements of AWS B2.1,ASME Welding section IX Welding and Brazing Qualifications,or other applicable qualification standard as required by the AHJ? Do you certify that the welding was conducted in compliance with a ❑ Yes ❑ No documented quality control procedure to ensure that(1)all discs are retrieved; (2)that openings in piping are smooth,that slag and other welding residue are removed;(3)the internal diameters of piping are not penetrated;(4)completed welds are free from cracks,incomplete fusion,surface porosity greater than 1/16 in.diameter,undercut deeper than the lesser of 251/o of the wal?thickness or 1/32 in.;and(5)completed circumferential butt weld reinforcement does not exceed '/32 in.? Cutouts Do you certify that you have a control feature to ensure that all cutouts(discs) Yes ❑ No discs are retrieved? Hydraulic Nameplate provided Yes ❑ No data nameplate If no,explain Remarks Date left in service with all control valves open � s NFPA Water-Based Fire Protection Systems Forms 3 of 4 Form 4 Nance of sprinkler contractor Smith Automatic Sprinkler Tests witnessed by The property o ner or their authorized agent(signed) Title Date Signatures 4Fors er contractor(s' Title 4 Ditto/ .`ems ..... Additional explanations and notes: - w- � q NFPA Water-Based Fire Protection Systems Forms 4 of 4